| NPI | 1972097574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 08) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203627) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2020-08-18 |